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https: //nww. stuff. nhs. uk Or Whither NHS net
Why? ¬Long personal involvement ¬Central to all the changes that surround us ¬Knowledge is power ¬Pretending it isn’t going to affect us is not an option
Why? ¬Not for coding clerks. – Who don’t have a long term future. ¬Not just for the IT department. ¬For us all, clinical workers and management workers alike.
What? ¬The NHS plan. ¬Information for health. • 1998 • Our LIS. • Our local funding. ¬Building the information core. • Jan 2001. ¬Other bits from all over.
Strands in All This ¬Communications ¬Records ¬Information
Strands in All This ¬Maybe money?
New Ways of Working ¬ Not bolting computers onto existing practices ¬ About redesigning work ¬ Redesigning care ¬ New pathways in the jargon
NET Targets Secondary care Clinical and support staff; ¬ 25% have desktop access by now – Really is 20% ‘ish ¬ 100% by 2002 Primary care GPs and managers ¬ 95% practices connected by now – Really is 80% ‘ish ¬ 90% desktop access by now – Really 50% ‘ish ¬ All 100% by 2002 But but but !
Uses Now ¬ Email ¬ Net browsing ¬ Information source ¬ Fax out (doesn’t work!) ¬ NSTS (not that reliable!) ¬ Reading the stuff the NHSe no longer publishes – cures insomnia. ¬ National address book? ¬ GP registration links. ¬ GP IOS links – for the brave.
Security ¬ Lags behind ¬ Caldicott – Awareness – Safe havens etc ¬ National audit scheduled for Dec 2001 – To BS 7799 ¬ NHS cryptography – Roll out spring 2002 – Public key encryption
What Next? – Uses of NHS net ¬National priorities are pathology requests and reports. ¬Then xray reports and requests. ¬Booking. ¬Discharge information.
Jargon EPR ¬ Electronic Patient Record – ? Attainable EHR ¬ Electronic health record – ? Holy grail
Clinical Terminologies ¬ Coding viz classifications ¬ Read 3 – Ends 2003 ¬ SNOMED – CT – Starts 2003 ¬ ? Legacy coding and classifications
EPR Level 3 ¬Integrated patient master index. • PAS. • Departmental systems (all departments) ¬Electronic clinical orders and results reporting. ¬Prescribing software. ¬Multi-professional care pathways.
EPR – Primary Care ¬RFA 99 legalises electronic records. ¬RFA 99 roughly equates with levels 4 -5 of secondary care EPRs. ¬Big problem is hospital letters. – ? Scanning. – ? EDI. ? 90% of practices by 2003
EPR – Primary Care ¬Integrated nursing and medical EPRs are coming. ¬National framework expected in Sept 2001. ¬End of many Korner MDS expected in next month or two. ¬Local initiatives already underway.
EPR – Out of Hours ¬ National programme ¬ To make summaries of GP EPRs available 24 hours a day ¬ First to GP out of hours services ¬ Then to A+E departments ¬ ? ? 2005
EPR – Mental Health ¬ Separate plans for mental health EPR. ¬ Separate funding stream. ¬ Integrated social and health records. ¬ Shared with social services. ¬ 25% by 2003 ? ¬ Locally ahead of the game.
EPR – Acute Hospitals ¬ Weird set of levels defined by the NHS ¬ 35% of acute trusts to have a level 3 EPR by 2002 ¬ 100% by 2005 ¬ Plenty of words and management speak out here – few systems!
Local Status ¬ 9 practices have full desktop NHS net connection. ¬ All practices should be connected by end of year. ¬ 16 practices have new LANs. ¬ 6 practices “paperless. ” ¬ 5 practices going “paperless. ”
Local Status ¬ FHN has connection. ¬ FHN has too poor a LAN for full desktop access. ¬ We have started a project for pathology reporting and requesting. ¬ We hope to add in radiology soon. ¬ Networking information sources is proceeding.
Information ¬ NICE ¬ Ne. LH ¬ Protocols ¬ Policies ¬ Guidelines ¬ Hi. MPs ¬ CHi. MPs And uncle tom cobbly….
Payroll and HR ¬ A national payroll and HR system is planned to start rolling out in 2004. ¬ Doing away with individual organisational arrangements.
Caveats ¬Knowing that nurses share the same records and can rapidly communicate with doctors will allow more task sharing, profoundly changing the nature of medical work.
Caveats ¬A lush information landscape where information is shared with patients leaves some things unknown: ¬If 1% of patients join the worried well? ¬Sharing all records with patients?
Caveats ¬How much extra time to spend capturing and structuring records?  – 30 minutes plus per day. –  Tierney et al JAMA 1993; 269: 379 -83.
Caveats ¬Are we ready to share our information with patients ? – The strategy says there are irresistible arguments for this.
Caveats ¬Control ¬Governance ¬Accreditation (and Re- ) ¬Performance related pay ¬Politics Or just my depixol dose is late.
A Personal Hope Clinical Needs Not Technology for its own sake